Friday, July 10, 2009

Choosing a doctor

After two pregnancies; one a vacuum-assisted epidural birth and the other a natural-hospital birth, I've realized that choosing the right doctor (or labor-attendant dare I say the word Midwife-gasp!), if you're committed to a natural birth, really does make a difference. When it comes to type one's and pregnancy, I agree that there is certainly a higher risk for the pregnancy than a non-diabetic woman. However, with good blood sugar control, I felt from my experience, the birth was no more risky than your average pregnant woman's birth. And here's where it matters how your doctor views pregnancy. The majority of maternal fetal specialists with whom I've had experience carried the risk category for me as a pregnant woman right through the end of the pregnancy until the baby was safely delivered, not willing to stray from the books a bit...using test after test and measuring the baby's growth religiously to ultimately choose the most conservative route for delivering the baby. Well, when my A1C was below 6.0 the entire pregnancy, which is considered normal for anyone, diabetes or not, I felt that the doctor was going overboard in telling me that he needed one last growth ultrasound (I'd already had 5) during the 37th week of pregnancy to make sure "attempting a vaginal delivery" would be safe!

Now, here's the disclaimer, I'm no doctor, and I realize diabetic moms are different and how they are treated during pregnancy is different to ensure the best outcome for baby and mama...however, my goal in this blog is that we look at the birth part of diabetic pregnancy differently. I believe, and have seen in the last 6 months, that Type 1 diabetic mom's CAN have an intervention free labor and delivery, which I believe is better for any woman, diabetes or not. So, let them do it! Enough of all of the "you can't deliver this large of a baby" talk. Just as there is a push right now in the mainstream to move away from intervention-ridden births in hospitals, let's apply that to diabetic moms who have good control and no obvious complications during pregnancy. Now there's where you need a good doctor to be the judge.

My recommendation to you if you want a natural birth, find a doctor who has done A LOT of them! Go and meet with doctors, and don't talk about a birth plan or how they "feel" about natural child birth...ask them, "what percentage of your births are completely intervention free?" How many natural births have you done in the last month? What percentage of their birth's are c-sections? How many of their patients births do they actually attend?

Those are the questions we realized the second time around we needed to ask. With my first pregnancy, I simply told the doctor I wanted a natural birth and asked how he "felt" about that. He politely said that would be fine as long as every thing went ok... RED FLAG! Most OBs are not trained in natural child birth...especially the specialists... they are surgeons! It's boring for them to do a natural birth, they are trained in a way that you NEED them to help you give birth...well, women all over the world and for centuries have given birth fine without anyone's help (agreed, there are emergency situations where help is needed, such as a breech baby or CPD-cephalopelvic disproportion-but in one study the FDA found the true incidence of CPD to be 1 or 2 cases in 2,500 while currently at least 100 out of every 2500 births are c-sections due to CPD according to Susan McCutcheon in Natural Childbirth the Bradley Way).

So, as I mentioned in the first posting of the blog, with baby #1 I went to the maternal fetal specialist only and submitted to all of the tests and ultrasounds. We had a healthy baby, but I suffered with post partum depression for months afterwards, I feel most of which was due to my feelings of failure. I did not have a natural birth (which remember, I think this is the way you should have a baby for the baby's AND mom's health) so I felt like I had failed my baby in that way. Then, he had many complications during the birth, once I got an epidural, and finally, he was taken from us for several hours after his birth, never having the chance to initialize good breast feeding and was never able to work up to a successful latch for nursing. The doctor I saw was WONDERFUL at managing my diabetes during pregnancy; however, he and his staff were not knowledgeable or experienced with natural childbirth and encouraged me to go the route they were comfortable with in getting epidural anesthesia and supplementing the baby after birth with formula in a bottle for low blood sugars.

With baby #2 I interviewed doctors and found a doctor who was experienced with natural birth and was accepting of my ability, despite having diabetes, to have a natural birth. I continued to see the same maternal fetal specialist I had seen with baby #1 with the agreement that the other OB would do the delivery and manage that side of my care. We had a successful natural birth at a different hospital where the staff were experienced in natural birth as well and studied the Bradley method of child birth rather than the Lamaze method, as with my first pregnancy. (That's another post in the future). I had no struggle with depression after the birth, in fact, I felt great from day 1! The physical recovery was like hours rather than months! I knew I had brought that baby into the world and I could take care of her, I didn't feel like I needed the hospital staff to help me care for the baby as I felt the first go round. She was put in my arms immediately after birth and only breastfed, never receiving supplemental formula. As I also mentioned in the first post for the blog, there is another type 1 woman who also had a successful natural delivery with this same doctor.

I felt the biggest difference in the births was the physician in charge of the delivery when it came to having a natural birth, the hospital's reputation for natural birth being a close second however. I would recommend checking out all of the resources available in your area on hospitals and doctors. I found that speaking with women who had experienced birth with doctors was the best way to really get a feel for where they stood on natural birth.

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